In a highly automated operation such as may be employed by a large organization, a requestor may request a particular action and a decision on whether to take the particular action may be performed in an automated manner. Specifically, the organization may employ software or the like that guides the process of making the decision. For example, in an insurance organization, the decision on whether to issue or update an insurance policy may be made with the aid of such decision software, either as employed directly by the requestor or by an agent or representative or the like (hereinafter, ‘representative’) of the insurance organization acting at the behest of the requestor.
Notably, the decision software may be provided with information as supplied by the requestor, and also with information obtained from other sources. For example, the decision software that determines whether an automobile policy can be issued for a particular individual as a driver may require the name of the individual and a driver's license or the like of the individual as supplied by the requestor, and may in turn employ such information to obtain a driving record for the individual from a driving record database as maintained by a governmental entity that issued the driver's license or the like.
As should be understood, based on all of the provided information the decision software determines whether the automobile policy can be issued or updated according to predefined underwriting standards provided to the decision software in a form recognizable by the decision software. Such predefined standards can be relatively simple or complex depending on circumstances. For example, a relatively simple standard may state that a policy cannot be issued for a driver below the age of 14. In contrast, a relatively complex standard may state that:
An operator [driver] may qualify for a Bodily Injury limit greater than their current limits or greater than $250,000 per person and $750,000 per occurrence, whichever is higher, on a policy only if any of the following are true:
1) The driving history for:
i) Each Active operator in the household has less than three At-Fault Accidents whose accident date is within the last three years of transaction effective date.
ii) Each Active operator in the household has less than three Minor convictions whose conviction date is within the last two years of the transaction effective date
iii) Each Active operator in the household has one or less Major Convictions whose conviction date is within the last seven years of the transaction effective date.
iv) The household has less than four At-Fault Accidents whose accident date is within the last five years of the transaction effective date.
v) The household has less than six Minor Convictions whose conviction date is within the last five years of the transaction effective date.
Significantly, the decision software may determine whether the automobile policy can be issued or updated according to a series of predefined underwriting standards that are applied generally sequentially, such as for example if the decision software applies both the relatively simple standard and the relatively complex standard set forth above. More generally, the decision software may determine whether the automobile policy can be issued or updated according to a process during which a number of predefined decision points are sequentially encountered. Notably, if at any decision point the decision software determines that the request is to be denied based on a corresponding standard or the like, the processing performed by the decision software may be halted and the requestor may be informed that the request is in fact denied, either directly or by way of the aforementioned representative.
Of course, the requestor may take issue with the denial of the request in which case the requestor may argue against the denial to the representative if already in contact therewith, or the requestor may be directed to contact such a representative to argue against the denial. As a result, the representative may be able to placate the denied requestor, perhaps by suggesting an alternate course of action. Alternately, the representative may determine that the denied requestor might have a legitimate argument worthy of further consideration, or the denied requestor may regardless demand such further consideration. As may be appreciated, such further consideration is likely performed by a human underwriter or the like, and may result in an over-ride of the denial at the decision point or a confirmation of the denial at the decision point.
In the prior art, no particular process was in place in order to submit the denial to a human underwriter for a possible over-ride. Thus, the representative had to contact the underwriter, perhaps by phone or mail or in person, and had to explain the circumstances of the denial at the decision point to the underwriter, after which the underwriter perhaps had to obtain additional information regarding the circumstances of the denial, and perhaps had to consult with written underwriting policies before arriving at a decision on whether to over-ride the denial.
Significantly, the determination on whether to over-ride the denial was not subject to any time constraints and accordingly hours or even days could elapse before the decision was arrived at and communicated to the requestor. Likewise, no mechanism was in place to effectuate the determination on whether to over-ride the denial, nor was any mechanism in place to memorialize the determination.
Accordingly, a need exists for systems and methods that allow an organization to provide real-time over-ride capabilities. In particular, a need exists for systems and methods that present a denial of a request at a decision point to a human underwriter such that the underwriter can issue a decision on whether to over-ride the denial in real-time.